Continuous infusion versus intermittent infusion of vancomycin: a systematic review and meta-analysis with a focus on nephrotoxicity, target attainment, and clinical outcomes
4 affiliations
- 1Zhejiang Wanli University
- 2Medical School of Ningbo University
- 3The First Affiliated Hospital of Ningbo University
- 4Ningbo College of Health Sciences
Abstract
Objective: Vancomycin is widely used for Gram-positive infections but has a narrow therapeutic window and significant nephrotoxicity risk. Whether continuous infusion (CI) offers advantages over intermittent infusion (II) remains debated. We conducted a systematic review and meta-analysis to compare CI versus II vancomycin regarding nephrotoxicity, target attainment, clinical outcomes, and time to therapeutic target.
Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to March 2026. Randomized controlled trials (RCTs) and observational studies comparing CI and II of vancomycin were included. Outcomes assessed were nephrotoxicity, target concentration attainment, clinical efficacy, microbiological clearance, mortality, and time to therapeutic target. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models.
Results: A total of 23 studies comprising 3,053 patients were included. CI was associated with significantly reduced nephrotoxicity (OR = 0.62, 95% CI = 0.48–0.79, I ² = 42%), higher target attainment (OR = 2.85, 95% CI = 2.12–3.84, I ² = 38%), and shorter time to therapeutic target (MD = –1.52 days, 95% CI = –1.98 to −1.06, I ² = 67%). No significant differences were observed for clinical efficacy (OR = 1.12, 95% CI = 0.86–1.46), microbiological clearance (OR = 1.08, 95% CI = 0.72–1.62), or mortality (OR = 0.94, 95% CI = 0.71–1.25).
Conclusion: Continuous infusion of vancomycin reduces nephrotoxicity risk, improves target attainment, and shortens time to therapeutic target compared with intermittent infusion, without compromising clinical efficacy or survival. These findings support CI as a preferred strategy in patients at heightened risk of renal injury.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261365683 , identifier CRD420261365683.
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BibTeX
@article{ma2026continuous,
title = {{Continuous infusion versus intermittent infusion of vancomycin: a systematic review and meta-analysis with a focus on nephrotoxicity, target attainment, and clinical outcomes}},
author = {Xunuo Ma and Leiting Xu and Jianfei Zhang and Xiudi Wu and Tao Tao},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1868531},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1868531/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Continuous infusion versus intermittent infusion of vancomycin: a systematic review and meta-analysis with a focus on nephrotoxicity, target attainment, and clinical outcomes
AU - Xunuo Ma
AU - Leiting Xu
AU - Jianfei Zhang
AU - Xiudi Wu
AU - Tao Tao
PY - 2026
DA - 2026/10/14
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1868531
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1868531/full
AB - Objective: Vancomycin is widely used for Gram-positive infections but has a narrow therapeutic window and significant nephrotoxicity risk. Whether continuous infusion (CI) offers advantages over intermittent infusion (II) remains debated. We conducted a systematic review and meta-analysis to compare CI versus II vancomycin regarding nephrotoxicity, target attainment, clinical outcomes, and time to therapeutic target. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to March 2026. Randomized controlled trials (RCTs) and observational studies comparing CI and II of vancomycin were included. Outcomes assessed were nephrotoxicity, target concentration attainment, clinical efficacy, microbiological clearance, mortality, and time to therapeutic target. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results: A total of 23 studies comprising 3,053 patients were included. CI was associated with significantly reduced nephrotoxicity (OR = 0.62, 95% CI = 0.48–0.79, I ² = 42%), higher target attainment (OR = 2.85, 95% CI = 2.12–3.84, I ² = 38%), and shorter time to therapeutic target (MD = –1.52 days, 95% CI = –1.98 to −1.06, I ² = 67%). No significant differences were observed for clinical efficacy (OR = 1.12, 95% CI = 0.86–1.46), microbiological clearance (OR = 1.08, 95% CI = 0.72–1.62), or mortality (OR = 0.94, 95% CI = 0.71–1.25). Conclusion: Continuous infusion of vancomycin reduces nephrotoxicity risk, improves target attainment, and shortens time to therapeutic target compared with intermittent infusion, without compromising clinical efficacy or survival. These findings support CI as a preferred strategy in patients at heightened risk of renal injury. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261365683 , identifier CRD420261365683.
SN - 1663-9812
ER -